Form Asd-127 - Abandoned Tangible Personal Property
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1North Carolina Department of State Treasurer
Holder Name:
Abandoned Tangible Personal Property
Holder FIN:
Branch Location:
ASD-127 (Revised 1/12)
Name of Contact Person:
Please read instructions on reverse side
Phone number of Contact Person:
DL # and
E-mail
State
Date of Birth
Address
SD Box #
Owner's Name:
Owner's Address:
Past Due
or Identifier #
(Last, First, Middle)
(Street, City, State, ZIP)
Rent*
Social Security #
$
Office Use Only
Office Use Only
Description of Items
Destroy
Submit
Description of Items
Destroy
Submit
DL # and
E-mail
State
Date of Birth
Address
SD Box #
Owner's Name:
Owner's Address:
Past Due
or Identifier #
(Last, First, Middle)
(Street, City, State, ZIP)
Rent*
Social Security #
$
Office Use Only
Office Use Only
Description of Items
Destroy
Submit
Description of Items
Destroy
Submit
DL # and
E-mail
State
Date of Birth
Address
SD Box #
Owner's Name:
Owner's Address:
Past Due
or Identifier #
(Last, First, Middle)
(Street, City, State, ZIP)
Rent*
Social Security #
$
Office Use Only
Office Use Only
Description of Items
Destroy
Submit
Description of Items
Destroy
Submit
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